Effects of colpotomic approaches on prognosis and recurrence sites of stage Ⅰa2-Ⅱa2 cervical cancer after laparoscopic radical hysterectomy / 中华妇产科杂志

Objective:To investigate the factors affecting the prognosis of stage Ⅰa2-Ⅱa2 cervical cancer after laparoscopic radical hysterectomy (LRH), and to compare the prognosis and recurrence sites of patients with different colpotomy paths.Methods:The clinical data of 965 patients with stage Ⅰa2-Ⅱa2 cervical cancer who underwent LRH in the First Affiliated Hospital of Army Medical University from January 2015 to December 2018 were collected. The median age was 47.0 years of all patients with a median follow-up of 62 months (48-74 months). Cox regression was used to perform the univariate and multivariate analysis of the clinicopathological factors associated with the prognosis that included disease-free survival (DFS) and overall survival (OS). Patients were categorized into LRH through vaginal colpotomy (VC group, n=475) and LRH through intracorporeal colpotomy (IC group, n=490) according to the colpotomic approaches. The prognosis and recurrence sites of patients in each group were compared. Results:(1) During the follow-up period, 137 cases recurred (14.2%, 137/965) and 98 cases died (10.2%, 98/965). The 5-year DFS and OS were 85.8% and 89.9%, respectively. In univariate analysis, positive vaginal margin (PVM) was significantly affected the 5-year OS of patients with cervical cancer ( P=0.023), while clinical stage, maximum diameter of tumor, degree of pathological differentiation, lymph node metastasis (LNM), depth of cervical stromal invasion, parametrium involvement, and uterine corpus invasion (UCI) were significantly associated with 5-year DFS and OS in patients with cervical cancer (all P<0.05). In multivariate analysis, clinical stage ( HR=1.882, 95% CI: 1.305-2.716), LNM ( HR=2.178, 95% CI: 1.483-3.200) and UCI ( HR=3.650, 95% CI: 1.906-6.988) were independent risk factors of 5-year DFS (all P<0.001). Clinical stage ( HR=2.500, 95% CI: 1.580-3.956), LNM ( HR=2.053, 95% CI: 1.309-3.218), UCI ( HR=3.984, 95%C I: 1.917-8.280), PVM ( HR=3.235, 95% CI: 1.021-10.244) were independent risk factors of 5-year OS (all P<0.05). (2) Different colpotomy paths did not significantly affect the 5-year DFS and OS of patients with stage Ⅰa2-Ⅱa2 cervical cancer. The 5-year DFS in VC group and IC group were 85.9% and 85.6% ( P=0.794), and the 5-year OS were 90.8% and 89.3% ( P=0.966), respectively. Recurrence patterns consisted of intraperitoneal recurrence, pelvic recurrence, vaginal stump recurrence, and lymph node and distant metastasis. The intraperitoneal recurrence rate of VC group was significantly lower than that of IC group [0.6%(3/468) vs 2.3% (11/485), P=0.037], while the rates of pelvic recurrence, vaginal stump recurrence, lymph node and distant metastasis and overall recurrence were not significantly different between two groups (all P>0.05). Subgroup analysis of patients with different clinical stages, LNM and UCI showed that statistical differences of the intraperitoneal recurrence rates between two groups were only in patients without LNM (0.5% vs 2.3%, P=0.030) or without UCI (0.7% vs 2.3%, P=0.037). Conclusions:Clinical stage, LNM, PVM and UCI are independent risk factors for the prognosis of patients with stage Ⅰa2-Ⅱa2 cervical cancer. For patients without LNM or UCI, LRH through VC could reduce the intraperitoneal recurrence rate, while it is not enough to improve 5-year DFS and OS of patients. Low proportion of intraperitoneal recurrence, intra-operative tumor cells spillage to vagina stump and pelvic cavity might be the explanation.

Clinical efficacy of modified vaginal hysterectomy in the treatment of uterine prolapse / 中国基层医药

Objective:To investigate the clinical efficacy of modified vaginal hysterectomy in the treatment of uterine prolapse.Methods:A total of 60 patients with uterine prolapse who received treatment in Fengtai County People's Hospital from July 2017 to October 2021 were included in this study. They were divided into control and observation groups ( n = 30/group) according to different treatment methods. The patients in the control group were treated with traditional vaginal hysterectomy (vaginal hysterectomy + vaginal anterior and posterior wall repair). The patients in the observation group were treated with modified vaginal hysterectomy (vaginal hysterectomy + vaginal anterior and posterior wall repair + autologous ligament suspension). The changes in surgical indicators and treatment effectiveness were evaluated between the two groups. All patients were followed up at 3, 6, and 12 months. Vaginal fornix prolapse and quality of life score were compared between the two groups. Results:The average drainage volume, average anal exhaust time, the average time to get out of bed, and the average length of hospital stay in the observation group were (520.13 ± 52.14) mL, (36.47 ± 5.72) hours, (32.48 ± 7.12) hours, and (16.48 ± 2.67) hours, respectively, which were significantly less or shorter than those in the control group ( t = 19.35, 18.25, 17.56, 17.35, all P < 0.05). The total response rate in the observation group was 93.3% (28/30), which was significantly higher than 80.0% (24/30) in the control group ( χ2 = 6.32, P = 0.005). At 3, 6, and 12 months after surgery, vaginal fornix prolapse did not occur in any patient in the observation group, but it occurred in two, three, and seven patients in the control group at the corresponding time points. Treatment efficiency was superior in the observation group to that in the control group ( χ2 = 4.21, P = 0.001). At 3, 6, and 12 months after surgery, quality of life score in the observation group was significantly higher than that in the control group [3 months: (60.71 ± 7.58) points vs. (50.69 ± 2.89) points; 6 months: (76.42 ± 3.50) points vs. (63.31 ± 8.67) points; 12 months: (81.30 ± 2.64) points vs. (70.72 ± 6.51) points], and the differences were statistically significant ( t = 7.21, 7.10, 6.31, all P < 0.05). Conclusion:The modified vaginal hysterectomy for the treatment of uterine prolapse has an ideal effect. It can effectively reduce the amount of drainage, shorten the exhaust time and the length of hospital stay, improve quality of life, and thereby is worthy of clinical promotion.

Mid-term efficacy of surgical treatments for post-hysterectomy vaginal vault prolapse: a retrospective study.

Background: The surgical treatment of post-hysterectomy vaginal vault prolapse (PHVP) has been reported in several clinical studies, but mostly are short-term studies. This study aims to explore the mid-term efficacy of surgical treatments for PHVP. Methods: A total of 138 PHVP patients underwent surgery from January 2005 to January 2020 at the Fourth Medical Center of PLA General Hospital, Beijing. The clinical data of 119 patients who completed follow-up were retrospectively analyzed. Both groups of patients are diagnosed Pelvic Organ Prolapse Quantification system (POP-Q) III-IV stage of prolapse, with obvious prolapse-related symptoms and requiring surgical treatment. Among them, pelvic floor reconstruction surgery (RPS) was performed in patients who wanted to retain vaginal function and colpocleisis were used for frail patients who cannot tolerate RPS. We used the POP-Q scores for the objective efficacy evaluation, and use the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) to evaluate the subjective symptom during follow up. Among them, 61 patients underwent pelvic floor RPS (Group R), and 58 received colpocleisis (Group C). Results: The surgeries in both groups were successfully completed, the median follow-up time after surgery was 4.3 years (0.25-13 years) and 5.3 years (0.33-15 years), respectively; the overall surgical success rate was 86.9% (53/61) and 100% (58/58), respectively; the subjective satisfaction rate was 90.2% (55/61) and 91.4% (53/58), respectively; and the PFDI-20 and PFIQ-7 scores in both groups were significantly improved compared with the preoperative levels (P<0.05). In Group R, 6 cases (9.8%, 6/61) were dissatisfied after surgery; in Group C, 5 cases (8.6%, 5/58) were dissatisfied after surgery. Conclusions: Reconstructive surgery and colpocleisis have a good mid-term effect on PHVP, with good outcome and few complications. The surgeon is expected to ascertain an appropriate surgical procedure based on the characteristics of the patient, the degree and the location of prolapse, in order to achieve the best surgical efficacy and minimize the damage.

Histerectomía vaginal convencional y vaginal asistida por laparoscopia en pacientes sin prolapso uterino / Conventional and laparoscopic-assisted vaginal hysterectomy in patients without uterine prolapse

RESUMEN Fundamento: la histerectomía es el procedimiento quirúrgico ginecológico más realizado a nivel mundial. En la actualidad no existe consenso sobre la vía de abordaje, donde es un problema a resolver. Objetivo: comparar los resultados de la aplicación de la histerectomía vaginal y la vaginal asistida por laparoscopia en pacientes con afecciones benignas del útero sin prolapso uterino. Métodos: se realizó un estudio descriptivo, transversal y retrospectivo en el Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey desde enero de 2017 a septiembre de 2019. El universo estuvo formado por todas las pacientes con enfermedades benignas del útero excluyendo el prolapso, operadas con las técnicas de histerectomía vaginal convencional y la asistida por laparoscopia en el período de estudio. Como fuente se utilizaron las historias clínicas y una planilla confeccionada para vaciar los datos. La variable dependiente fue: resultados que se clasificaron en satisfactorios o insatisfactorios. Las variables independientes fueron: edad, método quirúrgico, indicación quirúrgica, paridad, cirugías abdominales previas, tiempo quirúrgico, pérdidas sanguíneas transoperatorias, complicaciones y estadía hospitalaria. Resultados: predominó la histerectomía vaginal convencional a la asistida por laparoscopia. No existieron resultados insatisfactorios en ninguno de los dos grupos. El grupo de edad que prevaleció fue el de 40 a 49 años. La mayoría de las enfermas eran multíparas y sin antecedentes de cirugías previas. La histerectomía vaginal convencional mostró menor tiempo quirúrgico y las pérdidas sanguíneas fueron menores de 250 ml, con ambas técnicas. Las complicaciones de mayor frecuencia fueron las relacionadas con la cúpula vaginal, la estadía hospitalaria que predominó fue menor de 24 horas. Conclusiones: la histerectomía vaginal convencional, así como la asistida por la laparoscopia constituyen las técnicas quirúrgicas de elección ante las enfermedades benignas del útero que no sean el prolapso, en aquellas instituciones con personal entrenado y equipamiento necesario para su realización.

ABSTRACT Background: hysterectomy is the most widely performed gynecological surgical procedure worldwide. Currently, there is no consensus on when to use one or the other approach, which is a problem to solve. Objective: to compare the results of the application of laparoscopic-assisted vaginal and vaginal hysterectomy in patients with benign conditions of the uterus without uterine prolapse. Methods: a descriptive, cross-sectional and retrospective study was carried out at the Manuel Ascunce Domenech University Hospital in the period from January 2017 to September 2019. The universe consisted of all patients with benign diseases of the uterus excluding prolapse, who underwent surgery with conventional vaginal hysterectomy and laparoscopic assisted techniques in the study period. The medical records and a prepared spreadsheet were used as a source to empty the data. The dependent variable was the results; it was classified as satisfactory or unsatisfactory. Independents variables were: age, surgical method, surgical indication, parity, previous abdominal surgeries, surgical time, intraoperative blood loss, surgical complications, and hospital stay. Results: the conventional vaginal hysterectomy technique predominated over the one assisted by laparoscopy. There were not unsatisfactory results in no one of the two groups. The age group that prevailed in the patients was that of 40 to 49 years. Most of the patients were multiparous and had no history of previous abdominal surgeries. Conventional vaginal hysterectomy showed less surgical time and blood losses were less than 250 ml, with both techniques. The most frequent complications were related to vaginal cupules, as well as the prevailing hospital stay was less than 24 hours. Conclusions: conventional vaginal hysterectomy, as well as laparoscopic-assisted hysterectomy, are the surgical techniques of choice for patients with benign uterine diseases other than prolapse, in those institutions where there are trained personnel and the necessary equipment to carry them out.

Long-Term Experience with Modified McCall Culdoplasty in Women Undergoing Vaginal Hysterectomy for Pelvic Organ Prolapse.

OBJECTIVE: The incidence of post-hysterectomy vault prolapse following native tissue repair has been reported to be as high as 43%. The optimal way to maintain vault support is unknown. Our aim was to evaluate the long-term efficacy of modified McCall culdoplasty during vaginal hysterectomy for symptomatic uterine prolapse in preventing the recurrence of vaginal vault prolapse. METHODS: We conducted a retrospective chart review involving 490 patients who underwent vaginal hysterectomy with modified McCall culdoplasty, with or without a concomitant stress incontinence procedure, between January 2008 and December 2018 at Mount Sinai Hospital in Toronto. Data analyzed included patient demographics, preoperative prolapse staging, intraoperative and postoperative complications, and postoperative subjective and objective success rates. RESULTS: A total of 490 patients underwent vaginal hysterectomy with modified McCall culdoplasty. The mean follow-up period was 2.8 years. The objective success rate of vault support was 97.1%, and the subjective success rate was 94.1%. The total rate of reoperation for recurrence of vault prolapse was 1.0%. The objective cystocele recurrence rate was 8.6%, and 2.4% of these cases required reoperation. The objective rectocele recurrence rate was 4.7%, with 1.2% requiring reoperation. Unilateral ureteric kinking requiring intraoperative release of the McCall suture was recorded for 2.9% of patients. Overall, there was significant improvement in urinary, bowel, and prolapse symptoms post procedure. CONCLUSION: This cohort of patients who underwent modified McCall culdoplasty had low rates of vault prolapse recurrence and prolapse symptoms. The modified McCall culdoplasty technique practised at our institution is safe and effective in preventing post-hysterectomy vault prolapse.

Full-thickness vascularized vaginal flap as the fixation point in the surgical treatment of vaginal vault prolapse.

INTRODUCTION AND HYPOTHESIS: Post-hysterectomy vaginal vault prolapse is quite frequent and at the same time a challenging surgery for pelvic organ prolapse. METHODS: One of the most popular methods of treatment is sacrospinous fixation, including its mesh modification. RESULTS: Despite the high efficiency in the apical compartment, the incidence of the anterior compartment prolapse is quite high. Erosion remains an unsolved problem. A 44-year-old patient with grade IV post-hysterectomy prolapse underwent a sacrospinous fixation procedure with mesh according to the described technique. Surgery was performed successfully without complications. The duration of the operation was 40 min. A year after the operation, the recurrence of POP was not recorded in any compartments of the pelvic floor. It was possible to maintain the length of the vagina. Dyspareunia and vaginal erosion were not detected. The patient also noted a significant improvement in her quality of life. CONCLUSION: The demonstrated approach allows performing minimally invasive reconstruction of all three compartments of the pelvic floor. Moreover, the use of a full-thickness vascularized vaginal flap allows safely fixing the mesh to the vaginal vault, minimizing the risk of erosion and pain syndrome due to excessive tension.

Clinical analysis on the effectiveness of modified vaginal hysterectomy for the treatment of uterine prolapse in elderly women / 中华老年医学杂志

Objective:To examine the clinical effectiveness of modified vaginal hysterectomy for the treatment elderly women with uterine prolapse.Methods:Eighty-two elderly patients with uterine prolapse treated in the Affiliated Hospital of Jiangnan University from January 2017 to August 2020 were selected as research subjects, who were randomly and double-blindly divided into the control group and the observation group, with 41 patients in each group.The control group was treated with traditional vaginal hysterectomy, while the observation group was treated with modified vaginal hysterectomy.Surgical parameters(operating time, intraoperative blood loss and length of hospital stay), total clinical effectiveness rates and the incidences of complications in the two groups were compared.Results:The total effectiveness rate of the observation group was higher than that of the control group(97.6% vs.78.0%, χ2=7.291; P<0.05). The operation time[(71.3±15.5)min vs.(122.7±22.2)min, t=7.379, P=0.008], intraoperative blood loss[(122.5±15.3)ml vs.(297.7±20.7)ml, t=9.820, P=0.000]and hospitalization time[(7.2±1.5)d vs.(10.0±2.9)d, t=7.164, P=0.014]of the observation group were lower than those of the control group.The incidence of complications in the observation group was lower than that in the control group(0.0% vs.14.6%, χ2=7.159, P<0.05). Conclusions:Modified vaginal hysterectomy for elderly patients with uterine prolapse can help improve the clinical effectiveness and reduce the operating time, postoperative length of hospital stay and the incidence of postoperative complications.

Retrospective Analysis of Route Selection for Hysterectomy for Benign Indications at Ochsner Baptist Hospital.

Background: Hysterectomy, the most common gynecologic procedure in the United States, can be performed in a number of ways. A shift in surgical practice toward cost-effective and minimally invasive approaches provides an impetus to maximize early training in vaginal surgery for resident physicians. Methods: A total of 62 abdominal, 303 robotic, and 41 vaginal hysterectomies performed between January 1, 2015 and December 31, 2017 at Ochsner Baptist Hospital in New Orleans, LA, that met inclusion criteria were retrospectively reviewed with a previously published route selection algorithm. We applied the algorithm using preoperative and postoperative data collected via medical record review to determine if our practices favor minimally invasive approaches. Results: Analysis using preoperative variables identified 152 robotic cases that were vaginal hysterectomy candidates (50.2%). Postoperative analysis of the same cases identified 127 (41.9%) vaginal hysterectomy candidates. Among abdominal cases, 37 (59.7%) called for a less invasive approach by preoperative findings: 7 (11.3%) vaginal and 30 (48.4%) laparoscopic. The algorithm sorted only 25 of the 62 abdominal cases (40.3%) to the abdominal approach. Conclusion: Use of a hysterectomy route selection algorithm preoperatively improves identification of candidates for minimally invasive hysterectomy.

Direct target NOTES: prospective applications for next generation robotic platforms.

BACKGROUND: A new era in surgical robotics has centered on alternative access to anatomic targets and next generation designs include flexible, single-port systems which follow circuitous rather than straight pathways. Such systems maintain a small footprint and could be utilized for specialized operations based on direct organ target natural orifice transluminal endoscopic surgery (NOTES), of which transanal total mesorectal excision (taTME) is an important derivative. METHODS: During two sessions, four direct target NOTES operations were conducted on a cadaveric model using a flexible robotic system to demonstrate proof-of-concept of the application of a next generation robotic system to specific types of NOTES operations, all of which required removal of a direct target organ through natural orifice access. These four operations were (a) robotic taTME, (b) robotic transvaginal hysterectomy in conjunction with (c) robotic transvaginal salpingo-oophorectomy, and in an ex vivo model, (d) trans-cecal appendectomy. RESULTS: Feasibility was demonstrated in all cases using the Flex® Robotic System with Colorectal Drive. During taTME, the platform excursion was 17 cm along a non-linear path; operative time was 57 min for the transanal portion of the dissection. Robotic transvaginal hysterectomy was successfully completed in 78 min with transvaginal extraction of the uterus, although laparoscopic assistance was required. Robotic transvaginal unilateral salpingo-oophorectomy with transvaginal extraction of the ovary and fallopian tube was performed without laparoscopic assistance in 13.5 min. In an ex vivo model, a robotic trans-cecal appendectomy was also successfully performed for the purpose of demonstrating proof-of-concept only; this was completed in 24 min. CONCLUSIONS: A flexible robotic system has the potential to access anatomy along circuitous paths, making it a suitable platform for direct target NOTES. The conceptual operations posed could be considered suitable for next generation robotics once the technology is optimized, and after further preclinical validation.

Clinical effect of enhanced recovery after surgery management in patients with vaginal hysterectomy / 中国基层医药

Objective@#To analyze the effect of enhanced recovery after surgery program(ERAS) in perioperative management of vaginal hysterectomy.@*Methods@#The clinical data of 73 patients who underwent transvaginal hysterectomy for uterine fibroids, adenomyosis, middle pelvic defects, cervical lesions and endometrial lesions were retrospectively analyzed.All patients were divided into two groups according to the perioperative management method.The observation group (35 cases) received the enhanced recovery program, while the control group (38 cases) received the routine perioperative management.The general data and perioperative management indicators of the two groups were recorded and compared.@*Results@#There were no statistically significant differences between the two groups in mean age, body mass index, abdominal surgery history and diagnosis constitution(all P>0.05). The first feeding time[(7.6±1.3)h vs.(12.6±3.2)h], postoperative exhaust time[(15.5±4.6)h vs.(20.2±6.5)h], indwelling catheter time[(20.1±4.9)h vs.(28.4±6.8)h], mobilization time[(19.2±3.5)h vs.(24.2±7.9)h], the length of hospital stay[(4.5±0.7)d vs.(5.8±1.2)d]and hospitalization expense[(6 545.2±430.7)CNY vs.(7 953.8±653.3)CNY]of the observation group were less than those of the control group, the differences were statistically significant(t=8.069, 3.538, 5.938, 3.582, 5.590, 10.777, all P<0.05). There were no statistically significant differences between the two groups in the operation time[(45.3±20.8)min vs.(39.9±17.4)min]and the amount of bleeding[(69.4±32.2)mL vs.(57.0±24.5)mL](t=0.231, 0.067, all P>0.05).@*Conclusion@#The ERAS program perioperative management can speed up the postoperative recovery process, reduce the length of hospital stay and the financial burden of patients who underwent transvaginal hysterectomy.

Study on the complications of radical vaginal hysterectomy for locally bulky cervical cancer patients / 中国医师杂志

Objective To analyze the complications of radical vaginal hysterectomy in patients with locally bulky cervical cancer.Methods All 258 patients of early cervical cancer (stage Ⅰ A2-Ⅱ A) selected in our hospital during the period of June 2011 to June 2016 undergoing radical vaginal hysterectomy and laparoscopic pelvic lymph node dissection were analyzed.All cases were divided into observation (locally bulky) and control (conventional) groups.Comparison analysis was performed for complications of the two groups and the influence of neoadjuvant chemotherapy on the complications of local bulky patients.Results The incidence of complications in the observation group was 26 cases (27.9％),higher than that in the control group of 28 cases (17.0％),the difference was statistically significant (P ＜ 0.05).The incidence of bladder injury (5 cases vs 2 cases) in observation group was significantly higher than that in control group (P ＜ 0.05).For patients with locally bulky early cervical cancer,the incidence rate of complications of the neoadjuvant chemotherapy group (15.8％) was significantly lower than the simple operation group (36.4％) (P ＜ 0.05).The incidence rate of ureteral injury in neoadjuvant chemotherapy group (0 cases vs 6 cases) was significantly lower than that in simple operation group (P ＜ 0.05).Conclusions Early cervical cancer patients with locally bulky (stage Ⅰ B2/ 1Ⅱ A2) had higher incidence of complications of radical vaginal hysterectomy,and neoadjuvant chemotherapy can reduce the incidence of surgical complications.

Application value of transvaginal three-dimensional ultrasound technique in the perioperative period of pelvic floor disorder / 中国医师进修杂志

Objective To explore the value of three-dimensional ultrasonic technique in precise pelvic floor reparation. Methods One hundred and twenty-six patients with Ⅱ - Ⅳ degree pelvic organ prolapse were selected. The patients were divided into traditional group (57 cases, transvaginal hysterectomy and vaginal wall reparation) and study group (69 cases, transvaginal hysterectomy and vaginal wall reparation combined with indication of transvaginal three-dimensional ultrasound). The changes of perioperative indexes and postoperative recurrence rate were compared between 2 groups. Results There were no statistical differences in surgery time, intraoperative blood loss, retention catheterization time postoperative exhaust and defecation time duration in hospital and postoperative complication between 2 groups (P＞0.05). The subjective and objective cure rate 3 months after operation in both groups was 100.0% ; there were no statistical differences 6 months after operation between 2 groups (P＞0.05). The objective cure rates 12 and 24 months after operation in study group were significantly higher than those in traditional group: 20.0% (11/55) vs. 7.5% (5/67) and 27.3% (15/55) vs. 11.9% (8/67), and there were statistical differences (P＜0.05). Conclusions The recurrence rate of precise traditional pelvic floor reparation with the guidance of transvaginal three-dimensional ultrasound is significantly lower than that of traditional pelvic floor reparation.

Risk factors for urinary retention after vaginal hysterectomy for pelvic organ prolapse.

OBJECTIVE: To evaluate the risk factors for postoperative urinary retention in women who underwent vaginal hysterectomy for symptomatic pelvic organ prolapse. METHODS: The medical records of 221 women who underwent vaginal hysterectomy with anterior and posterior colporrhapy were reviewed. Urinary retention after catheter removal was defined as the presence of at least one of the following three conditions: 1) failure of first voiding trial necessitating catheterization, 2) first residual urine volume after self-voiding ≥150 mL, and 3) Foley catheter re-insertion. RESULTS: Urinary retention occurred in 60 women (27.1%). Multivariate and receiver operating characteristic curve analysis revealed that age (>63 years) and early postoperative day of catheter removal (day 1) was independent predictor for postoperative urinary retention. The incidence of urinary retention was significantly higher in women who removed indwelling catheter at day 1 (35.2%) than those at day 2 (12.0%, P=0.024), or day 3 (21.3%, P=0.044), but was similar to those at day 4 (25.0%, P=0.420). In women ≤63 years, urinary retention rate was not associated with the time of catheter removal after surgery; however, in women >63 years, the rate was significantly higher in day 1 removal group than day 2 to 4 removal group. CONCLUSION: Age and postoperative day of catheter removal appear to be associated with postoperative urinary retention in women undergoing vaginal hysterectomy for pelvic organ prolapse. Keeping urinary catheter in situ at least for one day after vaginal prolapse surgery could be recommended, especially, in women older than 63 years.

Risk factors for urinary retention after vaginal hysterectomy for pelvic organ prolapse

OBJECTIVE: To evaluate the risk factors for postoperative urinary retention in women who underwent vaginal hysterectomy for symptomatic pelvic organ prolapse. METHODS: The medical records of 221 women who underwent vaginal hysterectomy with anterior and posterior colporrhapy were reviewed. Urinary retention after catheter removal was defined as the presence of at least one of the following three conditions: 1) failure of first voiding trial necessitating catheterization, 2) first residual urine volume after self-voiding ≥150 mL, and 3) Foley catheter re-insertion. RESULTS: Urinary retention occurred in 60 women (27.1%). Multivariate and receiver operating characteristic curve analysis revealed that age (>63 years) and early postoperative day of catheter removal (day 1) was independent predictor for postoperative urinary retention. The incidence of urinary retention was significantly higher in women who removed indwelling catheter at day 1 (35.2%) than those at day 2 (12.0%, P=0.024), or day 3 (21.3%, P=0.044), but was similar to those at day 4 (25.0%, P=0.420). In women ≤63 years, urinary retention rate was not associated with the time of catheter removal after surgery; however, in women >63 years, the rate was significantly higher in day 1 removal group than day 2 to 4 removal group. CONCLUSION: Age and postoperative day of catheter removal appear to be associated with postoperative urinary retention in women undergoing vaginal hysterectomy for pelvic organ prolapse. Keeping urinary catheter in situ at least for one day after vaginal prolapse surgery could be recommended, especially, in women older than 63 years.

Clinical application of fast track surgery in patients with vaginal hysterectomy for non -prolapsed uterus / 中国基层医药

Objective To investigate the safety and feasibility of fast track surgery (FTS)in patients with vaginal hysterectomy for non -prolapsed uterus.Methods 1 1 0 cases of vaginal hysterectomy for non -prolapsed ute-rus with benign uterine disease were randomly divided into two groups:fast track group (n =55)and conventional group (n =55).The operative time,intraoperative blood loss,postoperative nausea and vomiting,anal exhaust time, postoperative hospital stay,medical cost and perioperative complications were compared between the two groups. Results In FTS group,the incidence rate of postoperative nausea and vomiting,the postoperative anal exhaust time, hospital stay,cost of hospitalization were 1 6.4%,(1 3.73 ±2.41 )h and (4.38 ±1 .08 )d,(7 541 .00 ± 253.1 7)yuan,respectively,which in the control group were 36.4%,(1 8.56 ±1 .54 )h,(4.89 ±1 .26 )d, (8 1 55.1 5 ±495.89)yuan,the differences were statistically significant between the two groups (χ2 =5.67,t =-1 2.53,-2.28,-8.1 7,all P 0.05).Conclusion FTS has good security.It can short the hospitalization time,reduce medical costs and improve the quality of life in patients who underwent vaginal hysterectomy for non -prolapsed uterus with benign uterine disease.

Histerectomía vaginal en úteros no prolapsados en mujeres nulíparas / Vaginal hysterectomy in non-prolapsed uterus in nulliparous women

Fundamento: en los últimos años se habla de un resurgimiento de la histerectomía vaginal como vía para operar a pacientes con enfermedades sin prolapso uterino. Hay varios factores que pueden prescribirla, entre ellos la nuliparidad. Objetivo: analizar los resultados de la histerectomía vaginal en pacientes nulíparas sin prolapso. Método: se realizó un estudio descriptivo transversal en pacientes nulíparas sin prolapso uterino a las que se les realizó histerectomía vaginal en el servicio de Cirugía General del Hospital Universitario Martín Chang Puga de Nuevitas, Camagüey, desde mayo de 1994 hasta mayo de 2011. La muestra quedó constituida por 60 pacientes. Para el análisis de los datos se utilizó la estadística descriptiva (exploratoria) con el uso de totales, por cientos, media, mediana, desviación estándar, máximo y mínimo. Resultados: el promedio de edad fue de 34 ±5,01 años. La paciente de menor edad tenía 33 años y la de mayor edad 45 años. La principal indicación quirúrgica que motivó la intervención fue el fibroma uterino, seguida del sangramiento uterino anormal. Las complicaciones postoperatorias se presentaron en un escaso número de pacientes. Las medias de estadía hospitalaria postoperatoria y tiempo quirúrgico fueron de 1,07±0,2 días y de 39,6±7,20 minutos respectivamente; la reincorporación fue de 20,4±5,2 días. Conclusiones: la nuliparidad no es un factor aislado ni absoluto para contraindicar la vía vaginal en el contexto de una histerectomía.

Background: in the recent years, vaginal hysterectomy has reemerged as a means for operating patients with diseases without uterine prolapse. There are some factors that can prescribe it; among them can be mentioned nulliparity. Objective: a cross-sectional, descriptive study was conducted in nulliparous patients without uterine prolapse who underwent a vaginal hysterectomy at the Department of General Surgery of the Martin Chang Puga University Hospital in Nuevitas from May 1994 till May 2011. The sample was composed of 60 patients. For the analysis of the data, the descriptive (scouting) statistic was employed with the use of totals, percents, average and median, standard deviation, maximum and minimum. Results: the average age was of 34 ±5.01 years. The youngest patient was 33 years old and the oldest 45 years old. The main surgical cause that motivated the intervention was the presence of uterine fibroids, followed by abnormal uterine hemorrhage. The postoperative complications were found in a limited number of patients. The average time of postoperative hospital stay was of 1.07±0.2 days. The average surgical time was of 39.6±7.20 minutes. The average time of reinstatement was of 20.4±5.2 days. Conclusions: nulliparity is not an isolated or absolute factor to contraindicate the vaginal method in terms of hysterectomy.

Vaginal hysterectomies in patients without uterine prolapse: ten-year experience.

OBJECTIVE: To review the results of vaginal hysterectomies in patients without uterine prolapse. DESIGN: Retrospective chart review. SETTING: University affiliated hospital, Hong Kong. PATIENTS: All patients who had vaginal hysterectomies in the absence of uterine prolapse from 1999 to 2005 inclusive (first period) and 2006 to 2009 inclusive (second period). MAIN OUTCOME MEASURES: The number of such hysterectomies, indications, operative procedures, complications, use of preoperative gonadotropin-releasing hormone agonist, and concomitant vaginal salpingo-oophorectomies performed. RESULTS: In all, 94 and 98 patients fulfilling the necessary inclusion criteria within the two respective periods underwent vaginal hysterectomy. The indications for hysterectomy in the respective groups were similar, and 89 (95%) and 90 (92%) of the patients were Chinese. The respective proportions having additional procedures were 11% versus 23% (P=0.018) and the respective vaginal bilateral salpingo-oophorectomy rates were 1% versus 15% (P<0.001). The vault haematoma rate decreased significantly in the second period (from 12% to 1%; P=0.002). There were no significant differences between the periods with respect to mean operative blood losses, uterine weights, and operating times. The use of gonadotropin-releasing hormone agonist resulted in reduced mean uterine sizes (12 weeks vs 10 weeks; P=0.041). A decreasing trend in mean operating times and blood losses was also observed after such use. Vaginal hysterectomy and bilateral salpingo-oophorectomies were successfully performed in 12 (80%) patients without laparoscopic assistance. For this procedure, a learning curve was also evident. CONCLUSIONS: Surgeons' experience can influence the complication rate and the chance of successful vaginal salpingo-oophorectomy. More liberal use of gonadotropin-releasing hormone agonist may further reduce the complication rate and allow more vaginal hysterectomies.

Clinical efficacy of improved vaginal hysterectomy and its influences on blood glucose and serum corticosteroid / 中国医师进修杂志

Objective To compare clinical efficacy between improved vaginal hysterectomy (IVH)and traditional vaginal hysterectomy (TVH) and its influences on blood glucose and serum corticosteroid levels.Methods One hundred patients undergoing hysterectomy were divided into using IVH (treatment group,50 patients) and TVH (control group,50 patients).Clinical efficacy,blood glucose and serum corticosteroid levels were compared between two groups.Results There was no significant difference in operation time between two groups (P＞ 0.05).The amount of intraoperative bleeding,postoperative exhaust time and postoperative vaginal bleeding time in treatment group were significantly less than those in control group [(86.7 ± 5.7) ml vs.(131.2 ± 14.5) ml,(24.8 ± 12.9) h vs.(42.8 ± 17.7) h,(16.5 ± 2.9) d vs.(24.3 ±6.7) d,P ＜ 0.05],and the time of blood glucose and serum corticosteroid levels returned to normal levels in treatment group were much earlier than those in control group.Conclusion The clinical efficacy of IVH is preonunced,and postoperative stress reaction is mild.

Vaginal hysterectomy in non-prolapsed uteruses: 6-year experience / Histerectomia vaginal em útero sem prolapso: experiência de 6 anos

OBJECTIVE: To evaluate the applicability of the technique of vaginal hysterectomy in non-prolapsed uterus. METHODS: A retrospective cohort study with 220 patients submitted to vaginal hysterectomy from January 2004 to July 2010 by the Vaginal Surgery and Pelvic Floor Team. Patients mean age was 44.4 years and they had on average three births (0-10 deliveries). The surgery was performed even in cases of previous abdominal surgery, and cesarean section was prevalent in 54.6% of patients. RESULTS: The mean uterus weight was 278.9g. The mean operative time was 93 minutes, and length of hospital stay was 24 hours after surgery in 65% of cases. There were no cases of visceral injury. The mean postoperative complication was cellulitis of the vaginal vault that occurred in 11 cases (5%) that received antibiotics. Mean blood loss corresponded to 1.4g/dL hemoglobin. From the analyzed sample, vaginal hysterectomy by vaginal route was feasible in 96.8% of patients, and abdominal conversion was necessary in 3.2%. CONCLUSION: Vaginal hysterectomy is a minimally invasive surgery, with fewer complications, and low morbidity. We believe that this procedure should be indicated to treat gynecological benign diseases.

OBJETIVO: Avaliar a aplicabilidade da técnica de histerectomia vaginal em úteros sem prolapso. MÉTODOS: Estudo de coorte retrospectivo de 220 pacientes submetidas à histerectomia vaginal no período de janeiro de 2004 a julho de 2010, pela Equipe de Cirurgia Vaginal e do Assoalho Pélvico. A média de idade dos pacientes foi de 44,4 anos e tiveram, em média, 3 partos (0-10 partos). A cirurgia foi realizada mesmo em casos de cirurgias abdominais prévias; a cesárea foi prevalente em 54,6% da amostra. RESULTADOS: O peso médio do útero foi de 278,9g. O tempo cirúrgico médio foi de 93 minutos, e o tempo de internação foi de 24 horas pós-operatórias em 65% dos casos. Não houve nenhum caso de lesão visceral. A complicação pós-operatória mais frequente foi celulite de cúpula, que ocorreu em 11 casos (5%), sendo tratadas com antibioticoterapia. A perda sanguínea foi, em média, de 1,4g/dL de hemoglobina. Foi possível a realização da histerectomia pela via vaginal em 96,8% das pacientes da amostra estudada e em 3,2% foi necessária a conversão para via abdominal. CONCLUSÃO: A histerectomia vaginal é uma cirurgia por orifício natural, minimamente invasiva, com baixas frequência de complicações e morbidade, sendo factível e segura para o tratamento de afecções uterinas benignas.

Clinical comparison study of laparoscopically assisted vaginal hysterectomy and transabdominal hysterectomy / 中国医师进修杂志

ObjectiveTo compare the clinical effects of laparoscopically assisted vaginal hysterectomy (LAVH) and transabdominal hysterectomy (TAH).MethodsOne hundred and twenty-six cases operated with hysterectomy were classified into LAVH group and TAH group by random digits table with 63 cases each.The operation time,intraoperative bleeding amount,exhaust time,hospitalization time and postoperative complications were observed and compared.ResultsThe operation time,intraoperative bleeding amount,exhaust time and hospitalization time was ( 115.6 ± 13.8 ) min,(92.5 ± 11.3 ) ml,(21.8 ±4.8) d and (6.1 ± 1.7) d in LAVH group,( 82.5 ± 8.7) min,( 112.3 ± 17.8) ml,(28.9 ± 6.2) d and (9.6 ±2.2) d in TAH group,there were significant differences between two groups (P＜0.05).The incidence of incision pain,delayed wound healing,vaginal stump infection,thrombophlebitis,and gastrointestinal disorders was 9.5％(6/63),0,1.6％(1/63),0 and 7.9％(5/63) in LAVH group,which was significantly lower than that in TAH group [52.4％(33/63),7.9％(5/63),11.1％(7/63),7.9％(5/63) and 22.2％ ( 14/63 ) ] (P ＜ 0.05).ConclusionCompared with TAH,LAVH can shorten exhaust time,hospitalization time,reduce intraoperative bleeding amount,decrease complication rate,which can be further applied in clinic.